+ The Development of Guidelines for the Admission to, and Transfer from Midwife-led Units in N. Ireland Dr Maria Healy Head of Midwifery UCD & Clinical Tutor QUB/WHSCT Dr Patricia Gillen Head of R&D for Nurses, Midwives and AHPs, SHSCT/Honorary Fellow, University of Ulster LSA Conference 30 th January 2015

+ Overview Background Aim, Objectives and Timeline Steering & Working group membership Process of Guideline Development to date Consultation & Peer Review 2

+ Background Steady increase in the provision of midwife-led units (MLU) in Northern Ireland, since the first unit opened in 2001 Most recent unit officially opened in January 2015 Five AMUs Three FMUs 3

Map of Midwife-led Units in N. Ireland Altnagelvin AMU opened 2010 Mater FMU Opened 29 th April 2013 SWAH AMU Opened 2013 Craigavo n 1 st AMU opened 2001 Lagan Valley FMU opened 2011 Ulster AMU opened 2008 Downe FMU opened 2010 Daisy Hill AMU opened 2014

+ Background Individual MLUs use locally developed eligibility criteria (Healy, 2013) Impact: Some women are unnecessarily excluded from admission to an MLU, can be transferred to an obstetric unit without good reason or inadvertently included Contrary to the evidence – NICE (2014), Sandall et al. (2013), Devane et al. (2010) The provision of MLUs seen as an important component in the Maternity Care Strategy and it’s implementation (DHSSPS 2012) Midwives expressed the need for an evidence based guideline which would assist women and maternity care professionals in their decision-making processes about place of labour and birth (Healy, 2013) Subsequently, an application to Guidelines and Audit Implementation Network (GAIN) to develop a regional guideline for admission to and transfer from midwife-led units in N. Ireland and funding granted in January

+ Project Aim: To standardise guidance for women and maternity care staff with regard to the admission to, and transfer from MLUs, ensuring a consistent approach for women seeking access to care in a MLU across Northern Ireland. 6

+ Objectives To review the current local, national and international evidence for criteria as applied to women seeking admission to, and requiring transfer from MLUs. To develop a standardised guideline based on the current evidence in conjunction with an expert panel of maternity care staff and service users. To disseminate guidelines to regional primary and secondary maternity care staff, MLUs and service user group in N. Ireland. To develop and disseminate a user friendly information leaflet relating to the criteria for admission to, and transfer from, a MLU. 7

Time Line TimelineOn-going WorkAgreed Actionresponsible person/s Months 1-3 (Jan 14 -Mar 14)  Define remit of guideline  Plan development process  Share relevant knowledge and experience  Identify key questions/terms for literature search and discuss requirements of systematic literature review (with advice from GAIN Manager)  Agree dates for meetings 1.Agree membership of Group(s) 2.Finalise remit 3.Commence literature search All Months 1-10 (Jan 14 – Oct 14) Clarify criteria used to select or reject papers Review abstracts to select papers for detailed review Detailed literature review, grading and synthesis of evidence  Bring findings to steering group 1.Literature search & appraisal 2.On-going review of evidence 3.Steering group review Working Group Maria and Patricia Working Group Months (Nov 14-Jan 15)  Draft guidelines derived and prepared from evidence review Steering group meeting to present and discuss draft guidelines Draft Guidelines Present draft guidelines to steering group 1.Working group 2.Maria and Patricia Months (Feb 15-Apr 15)  Feedback from steering group incorporated into draft guidelines.  Draft edited by group with assistance from GAIN Manager  Guideline sent for external peer review  Feedback from external reviewers - incorporated into draft guideline 1.Steering group feedback 2.Peer review 3.Peer review feedback and final editing 1.Working Group 2.Maria and Patricia 3.GAIN Months (Apr 15-Jun 15)  Review by GAIN Editorial Group  Publication and dissemination Maria and Patricia GAIN 8

+ Steering & Working group membership Meetings held regularly commencing 24 th Feb 2014 Membership: Heads of Midwifery, Midwife-Led Care Managers, GPs, NCT rep, MSLC Reps, Obstetricians, Anaesthetists, Paediatricians, PHA, LSAMO, DHSSPS Midwifery Adviser, NIPEC, Women’s groups, 10,000 Voices Project leads 9

+ Process of Guideline Development to date A Faciliated discussion at the first meeting led to the identification of key questions about specific criteria e.g. BMI, Age, IOL, VBAC, Group B Strep, SROM Issues relating to women’s choice and experience 10,000 Voices ‘Briefing Paper Relating to Experience of Maternity Care in Midwifery-led Units in Northern Ireland’ (August 2014) Collation of a large range of international and national literature and evidence Guideline developed - Inclusive approach Identifying at each point of maternity care contact the most appropriate lead maternity care professional Guideline currently in fifth draft Next step involves forwarding it to the Clinical Directors for Obstetrics and Gynaecology & Heads of Midwifery of each Trust, for their comments. Further meetings planned between February and May

+ Consultation & Peer Review Public consultation Peer review Sign-off from the Maternity Care strategy Implementation project Information leaflet for women and their families Further work: Evaluation of the criteria and its implementation 11

+ Other Work 10,000 Voices ‘Briefing Paper Relating to Experience of Maternity Care in Midwifery-led Units in Northern Ireland’ (August 2014) NICE Intrapartum draft guideline consultation submission 24 th June 2014 Input into: Maternity Strategy Implementation project group Community Care project group Invitation to present at: LSA Conference Jan 2015 RCGP – ‘Problems in Pregnancy Meeting’ Feb

+ Thank You 13